‘Spirit of Humanity Awards’ 2013
AmeriCares India is a nonprofit organization providing humanitarian medical aid on a regular basis and responding
immediately in disaster situations. Currently AmeriCares India works with international and local charitable organizations
including governmental and non governmental agencies, hospitals to assess humanitarian needs of health and respond to
those that are most critical, across 26 states involving our network of 120 affiliate partners across India.
‘AmeriCares India Spirit of Humanity Awards’ was established in 2010 as India’s first healthcare awards to honor and
recognize individuals or organizations that have made outstanding contributions towards improving healthcare and creating
a healthier & stronger society.
The objective of the awards is to provide a platform and award unprecedented and exemplary work in the field through
rigorous search, nomination and selection of people or organizations by using a transparent process, an independent jury
and third party oversight.
Nominees: Organizations & Individuals can nominate themselves or others.
Nominees must be:
a. Indian Citizens above the age of 18yrs or
b. Registered organizations that have been in operation for a minimum of 3 years in India: Non-governmental, charitable or
nonprofit entities, government or private hospitals, private companies, government agencies, universities and multilateral
organizations are eligible for consideration.
c. Individuals or organizations who have won the award would not be eligible to reapply for 3 years in the same category for
which they won the award. However they could apply in a different category.
Registration documents are required for nonprofit institutions and must be mailed along with the Nomination Form. All
necessary documents are listed below.
Organizations registered with GuideStar India may submit their GSN (GuideStar Number)
Contact with any jurors by a nominee or by somebody on behalf of the nominee will be grounds for automatic
1. Nomination Open
( Online submission is encouraged ; hardcopies plus October 2, 2012
softcopies in CDs are also accepted by courier)
2. Deadline for accepting nominations: November 30, 2012
3. Screening Committee Meeting February 2013
4. Intimation to finalists February 2013
5. Oral Presentation by finaliststo Jury in Mumbai April 6, 2013
6. Award Ceremony at Mumbai April 6, 2013
Awards will be given out in various categories like:
I. Child Nutrition
II. Women's Health
VI. Oncology – Service
V. Oncology – Research
VI. Neurology/ Mental Health
VII. Jury's Choice Award - for those who do not fall into the above categories
Based on additional support, we may add more categories.
A) For the winner:
1. Donation of Rs. 1 lakh to your charity or a charity of your choice
3. Certificate of Excellence signed by the international jury.
B) For other finalists:
All finalists shall receive a Certificate of Honor signed by the international jury.
(Please check our website for regular updates)
Individuals/organizations will be evaluated on the basis of their work done in the last 5 years (highlight
accomplishments in the period of 2007-2012. Contributions can be in any or multiple aspects of healthcare – e.g.
education, treatment, prevention, research, capacity building, advocacy, processes, inventions, methods, guidelines,
etc. Nominees will be assessed on the following parameters (as many as applicable for each nominee):
1. Vision & Mission
2. Objectives of the Organization/ Individual
3. Working in which area/s in India
4. Details of work/ programs of the last 5 years ( Annual)
5. Populations or individuals served, and how they benefited
6. Measurable outcome and benefits
7. Leadership qualities/ Role models to others
8. Use of innovative and creative approaches
9. Ability to scale up and adaptability across geographic and organizational boundaries
10. Organizational capacity (including financial and programmatic stability) / Number of Staff ( full time part
time & volunteers)
11. Details of Past budget ( last 3 yrs)
12. Collaboration with other organizations / Individuals
13. Recognition/ Achievement
14. Confirmation by Referees
15. Applications should include a brief (500 words max) describing their contribution in respect to the specific
category in you like to nominate yourself.
The following documents are required for nominations:
1. Completed word document of the nomination form
2. PowerPoint presentation with salient points in the format provided.
3. Registration Certificate
4. Registration certificate under Section 12 A
5. Audited Accounts of last 3 years
6. Acknowledgement of Income Tax return along with IT return filed (last 3 years)
7. FCRA certificate (if any) and latest copy of FCRA return FC-3
8. Pan Card Xerox
9. Annual Reports of the last 3 years
10. Applications should include a brief description of how the nominee has made a sustained contribution in the
respective Award category
11. NGOs registered with GuideStar India can skip item 3 & 8, upload 4,5,7 and send the rest.
1. Screening of all completed nominations received by the deadline will be performed by a core committee consisting
of healthcare professionals from various specialties as well as experts from other fields.
2. Shortlisted nominations will be required to come personally and make a presentation on the day of the event to an
international Jury consisting of health professionals & eminent people from different sections of the society.
3. A winner will be selected by the Jury from the presentations made for in each Award Category.
4. The entire processes will be done with the help of volunteers and certified by KPMG (Knowledge Partner)
The Nomination Form and the PowerPoint presentation along with all documentation, CV (if applicable), supporting
documents, and the narrative (if any) must be received by us no later than Friday November 30, 2012.
The preferred mode of application is online. All supporting documents should be scanned and uploaded. An
acknowledgement will be sent only to nominees whose completed application is received.
Completed Nomination Forms and PowerPoint presentation (hard copy along with the copy on CD) could also be sent to
By Courier : AmeriCares India Foundation, Seagull House, 1st floor, P.No. 6, Shivaji Colony, Chakala, Andheri
Kurla Road, Andheri East, Mumbai 400099
Website : www.americaresindia.org
To fill the form online: www.spiritofhumanity.net
Please contact Aiswarya Vijayadharan at Tel. No.: 022 6556 8098 for more details or any clarifications email at
Name of the nominee
Organization / Individual - as per valid legal
Is the nominee an individual or a organization
(please tick one option)
Is the nominee individual a citizen of India &
above 18 years of age at the time of filing this Yes No
nomination? (Applicable for Individuals only)
Guidestar India. If yes, pls write GSN: ________
Is the nominee registered with any of the
GiveIndia. If yes, pls write reference #: ________
following organizations (Tick if yes and write the
Samhita . If yes, pls write reference #: ________
reference number (if any))
Indian Ngos. If yes, pls write reference #: ________
If yes, pls write reference#: _____________
Is the nominee organization registered in India
Registration No. ___________________
Date of Incorporation/Registration
Date : Month : Year :
(organizations) or Date of Birth (individuals)
For which of the following Award Category is Child Nutrition Neurology/ Mental Health
this nomination being filed? Infections Women's Health
Oncology -Service Oncology Research
(Please tick ONLY ONE category
Jury's Choice Award-for those who do not fall into the above categories
Registered Address (Complete Address : as can _________________________________________________
be supported with valid legal document) _________________________________________________
Mailing Address ( Applicable if different from _________________________________________________
the above) _________________________________________________
Mr. Ms. Mrs. Dr.
Name & Salutation of the nominee
First Name :
(For Organization : Mention name of a person from
Middle Name :
the organization who is authorized to represent it
Last Name :
Email Id: __________________________________ Cell Phone No: _ _ _ _ _ _ _ _ _ _ _ _
Landline No: STD Code : No: Fax No ( If Available) _________________
Please describe the nominee’s work till date (in the appropriate Award category) & a record of all achievements made
over the last 5 years (2007– 2012). For fields that are not applicable, please leave blank or write not applicable. (Add
pages if required)
1. Vision & Mission
2. Objectives of the Organization / Individual ( Add pages if required)
3. Working in which area/s in India ( Add pages if required)
4. Details of work/ programs of the last 5 years ( Annual) ( Add pages if required)
5. Populations or individuals served, and how they benefited ( Add pages if required)
6. Measurable outcome and benefits ( Add pages if required)
7. Leadership qualities/ Role models to others ( Add pages if required)
8. Use of innovative and creative approaches ( Add pages if required)
9. Ability to scale up and adaptability across geographic and organizational boundaries ( Add pages if
10. Organizational capacity (including financial and programmatic stability) / Number of Staff ( full time
part time & volunteers)
11. Details of Past budget ( last 3 yrs)
Financial Years Total Income (Rs in Lakhs) Total Expenditure (Rs. in Lakhs)
2011 - 2012
2009 - 2010
12. Collaboration with other organizations / Individuals ( Add pages if required)
13. Recognition/ Achievement ( Add pages if required)
14. Applications should include a brief (500 words max) describing their contribution in respect to the
specific category in you like to nominate yourself.
Please provide two individuals who can serve as additional references for the Nominee.
Address State : Pin Code :
Telephone : Email Add :
Address State : Pin Code :
Telephone : Email Add :
LIST OF SUPPORTING DOCUMENTS/ OTHER DOCUMENTS ENCLOSED (INCLUDING CV
AND NARRATIVE IF APPLICABLE)
UNDERTAKING BY THE APPLICANT/ NOMINEE
1. All statements mentioned in the Nomination Form & the narratives (if any) are true to the best of our knowledge &
2. If shortlisted for an Award, the nominee shall be available on 6th April 2013 to make the presentation to the Jury and
also at the Award ceremony in Mumbai. In case the nominee is not able to attend the ceremony, the Award shall be
given to the ‘alternate’ Awardee selected by the Jury for that Award category.
3. We will accept the Jury’s decision to be final & binding.
4. We give permission to AmeriCares India Foundation to use the nominee’s name, photograph, etc. in any promotional
material that they want to develop.
5. The references are not related to me/ us.
6. We authorise AmeriCares India Foundation to share our documents and contact details with GuideStar India to
facilitate our registration.
7. We are aware that the Jury may decide not to select anyone in any Award category if the nominations are not of
sufficiently high standards.
8. We give our consent to AmeriCares India Foundation & their representatives to do the due diligence & verify all
accuracy of the information provided in the application.
9. We will not attempt to influence the selection process or contact any jury member. Also we are aware that any such
attempt shall automatically disqualify this application.
Signed on ___ date of _______ 2012. Signed on ___ date of ________ 2012
Name & Signature of Applicant Name & Signature of Nominee
(if different from Applicant)
FOR OFFICE USE ONLY
Nomination No: / Date Form Received: /
Date Referee 1 Comments Received / Date Referee 2 Comments Received /
Completeness Verified: Yes / No No of Supporting Documents Recd
Date of Birth/ Registration Proof Appropriate Yes / No
Comments: Category Assigned: